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General NPI Number Information
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NPI Number | 1316690290
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Entity Type | Organization
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Legal Business Name | MACOMB FAMILY LAB SERVICES LLC
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 01/31/2022
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Provider Practice Location Address
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Address Line | 31110 SARATOGA AVE
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City | WARREN
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State | MI
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Zip | 48093-1619
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Country | US
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Telephone | 313-727-5009
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Fax |
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Provider Business Mailing Address
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Address Line | 26140 CROCKER BLVD STE 1013
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City | HARRISON TOWNSHIP
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State | MI
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Zip | 48045-2454
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Country | US
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Telephone | 313-727-5009
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JONI MCCOY
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Credential | FNP-C
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Telephone | 313-727-5009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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